Tayside Respiratory Research Group, Ninewells Hospital and Medical School, Dundee, UK.
Tayside Respiratory Research Group, Ninewells Hospital and Medical School, Dundee, UK University of Dundee, Dundee, UK.
Thorax. 2014 Jul;69(7):609-15. doi: 10.1136/thoraxjnl-2013-203996. Epub 2014 Apr 17.
Evidence suggests that platelets play a significant role in inflammation in addition to their role in thrombosis. Systemic inflammation is linked to poor short and long term outcomes in COPD. Increased platelet activation has been reported in acute exacerbations of COPD (AECOPD). We investigated whether thrombocytosis is independently associated with poor outcomes following AECOPD.
An observational cohort study of patients hospitalised with AECOPD was performed. Patients were >40 years with spirometry confirmed COPD admitted between 2009 and 2011. Platelet count was recorded on admission. The primary outcome was 1-year all-cause mortality. Secondary outcomes included inhospital mortality and cardiovascular events. Analyses were conducted using logistic regression after adjustment for confounding variables.
1343 patients (49% male) were included. Median age was 72 years (IQR 63-79 years). 157 (11.7%) had thrombocytosis. Thrombocytosis was associated with both 1-year mortality and inhospital mortality; OR 1.53 (95% CI 1.03 to 2.29, p=0.030) and OR 2.37 (95% CI 1.29 to 4.34, p=0.005), respectively. Cardiovascular hospitalisation was not significantly increased (OR 1.13 (95% CI 0.73 to 1.76, p=0.600)) in patients with thrombocytosis. Aspirin or clopidogrel treatment correlated with a reduction in 1-year mortality (OR 0.63 (95% CI 0.47 to 0.85, p=0.003)) but not inhospital mortality (OR 0.69 (95% CI 0.41 to 1.11, p=0.124)).
After adjustment for confounders thrombocytosis was associated with increased 1-year mortality after exacerbation of COPD. Antiplatelet therapy was associated with significantly lower 1-year mortality and may have a protective role to play in patients with AECOPD.
有证据表明，血小板除了在血栓形成中起作用外，在炎症中也起重要作用。全身炎症与 COPD 的短期和长期预后不良有关。在 COPD 急性加重（AECOPD）中已报道血小板活化增加。我们研究了血小板增多症是否与 AECOPD 后的不良结局独立相关。
对 2009 年至 2011 年间因 AECOPD 住院的患者进行了一项观察性队列研究。患者年龄>40 岁，经肺量测定证实患有 COPD。入院时记录血小板计数。主要结局为 1 年全因死亡率。次要结局包括住院死亡率和心血管事件。使用逻辑回归分析在调整混杂变量后进行分析。
纳入 1343 例患者（49%为男性）。中位年龄为 72 岁（IQR 63-79 岁）。157 例（11.7%）有血小板增多症。血小板增多症与 1 年死亡率和住院死亡率均相关；OR 1.53（95%CI 1.03-2.29，p=0.030）和 OR 2.37（95%CI 1.29-4.34，p=0.005）。心血管住院治疗并未显著增加（OR 1.13（95%CI 0.73-1.76，p=0.600））在血小板增多症患者中。阿司匹林或氯吡格雷治疗与 1 年死亡率降低相关（OR 0.63（95%CI 0.47-0.85，p=0.003）），但与住院死亡率无关（OR 0.69（95%CI 0.41-1.11，p=0.124））。
在调整混杂因素后，血小板增多症与 COPD 加重后 1 年死亡率增加相关。抗血小板治疗与 1 年死亡率显著降低相关，在 AECOPD 患者中可能具有保护作用。
